Application

Polk County Clerk of Courts is an equal opportunity employer dedicated to non-discrimination in employment. We select the most qualified individual for the job based on job-related qualifications regardless of race, color, age, sex, religion, national origin, disability, ancestry, marital status, credit history, sexual orientation, arrest and court record, genetic information, veteran status or any other status protected by federal, state or other applicable laws.

GENERAL INFORMATION 03/17/2023

Last Name First Name Middle Name Nick Name

Villaronga Milagros

Street Address City, State Zip

747 Gladiola Drive Auburndale, FL 33823

Email Contact Phone Home Phone Cell Phone

ad2ycb@r.postjobfree.com 609-***-****

Have you ever been convicted of or pled no contest to a felony or a serious misdemeanor? Yes X No If yes, list dates and details (a conviction will not necessarily bar you from employment): Why do you want to work for Polk County Clerk of Courts? Would love to have a government job I love the courts my Daugther has been working for the courts for many years in Nj she loves it

Have you ever worked for Polk County Clerk of Courts before? Yes X No If yes, list dates and supervisor(s): Do you have any friends or relatives that work for Polk County Clerk of Courts? Yes X No If yes, enter their names and relationship to you: Daughter works in court in nj she's the judges secretary Are you currently employed? Yes X No If yes, may we contact your current employer? Yes No Have you ever been terminated, asked to resign or left a job without notice? Yes X No If yes, explain the circumstances and employer:

If required for this position, do you possess a valid driver's license? X Yes No If so enter State, License # and Class:

v465-540-57-907-0 ClassE

If a driver's license is required, have you received any tickets in the last three years for moving violations? Yes X No If so, list the date and type of each violation:

POSITION

Position applied for or type of position desired:

PL579- Fiscal Specialist/Cashier - Treasury/AR/Clerk to the Board When can you start? Immediately

If required can you work overtime? X Yes No Can you work holidays? X Yes No Why do you feel you're qualified for this position? I've always worked in an office settings a lot of paperwork filing data entry/ cash entry How did you hear about this position? Indeed

EDUCATION AND TRAINING

Are you a high school graduate? X Yes No If not, have you passed the GED? Yes No List your High School, Colleges, Business Schools, and Vocational Schools and Military Training (with the most recent first). You may use "+ Add Another Education" to add additional entries. Name and Location # of Yrs Attended Major/Area of Study Degree(s) Theadore Roosevelt high school 3 English Diploma

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List any academic honors, scholarships, fellowships, academic honorary societies, etc. If you have served in the Armed Services, list your duties and duty stations, special training, and rank at discharge: WORK EXPERIENCE

List your work experience, starting with your most recent employment (do NOT enter "see resume"). You may use "+ Add Another Job" to add additional entries.

Employer Address

Condon & Skelly 121 maple shade NJ

Supervisor(s) Name,Title May we contact this employer? Phone Eligible for rehire? Karen Toni X Yes No 609-***-**** Yes X No

Starting Date Ending Date Reason for Leaving

05/08/1987 02/07/2002 Care for my spouse who had a traumatic accident they held my job position for me for a year but due to the spouse injuries I was unable to go back worked with this company for many years

Starting Title Starting Pay Rate Starting Duties

Sending bills 10.00 hrly New business/ renewals

Ending Title Ending Pay Rate Ending Duties

customer service

representative

15.00 Representative/ cash entry

OTHER SKILLS

If you are fluent in any languages other than English list them here with details (fluent, conversational, etc): Spanish

List any special training, work-related skills, achievements, equipment certification, occupational licenses, military training, certifications or registrations relevant to this position. If hired, you may be required to submit copies for verification. List any Memberships in Professional or Civic Organizations. (Exclude those which may disclose your race, color, religion or nation origin).

State any additional information you feel may be helpful to us in considering your application. Iam a fast learner and I really need a job right now this is an ideal job for me . PROFESSIONAL REFERENCES

Enter the names and contact numbers of three (3) business/work references of people who are not related to you, or if not applicable you may enter school or personal references of people who are not related to you. Name Position/Company/Address Yrs Known Contact Number/Email Jeremias ramos Friend for many years 13-609-***-**** Kathy vicente brown Ex co worker 15-347-***-****

Christina Police officer Philadelphia 10-215-***-**** Page 2

SIGNATURES (Initials and Signature were entered electronically and verified by applicant's email and password) Mv Safe Driver Policy:

All applicants applying for a position with Polk County Clerk & Comptroller that require a valid Florida Driver's License, Chauffeur's License, or a Commercial Driver's License at the time of employment will not be given consideration for employment if they are not at least 18 years of age, and if their driving record reflects they: 1) Have been convicted of an alcohol/drug related offense within 36 months prior to making application. 2) Have been convicted of two (2) alcohol/drug related offenses within (10) years prior to making application. 3) Have a suspension, revocation, or restriction due to moving violations within 36 months of making application. 4) Have a temporary license from the Court permitting them to travel to and from work only, or permitting them to drive at work only.

5) Have accrued 12 points on their driving record within the 24 months prior to making application. 6) Have accrued 18 points on their driving record within the 36 months prior to making application. 7) Cannot provide proof of insurance when required to use their personal vehicle as part of their daily job duties. SPECIAL NOTES:

1) The Clerk & Comptroller also reserves the right to disqualify an applicant from a driving position based on their total driving record, even if they meet the above stated requirements. 2) All applicants applying for these positions must have a valid driver license which is appropriate for the position for which they are applying

Mv I understand that Polk County Clerk of Courts may contact my previous employers and I authorize those employers to disclose to Polk County Clerk of Courts all records and information pertinent to my employment with them. Mv I understand that Polk County Clerk of Courts may conduct a background check, and I authorize Polk County Clerk of Courts and any third-party acting on Polk County Clerk of Courts's behalf to conduct such background investigation. In connection therewith, I agree that if requested, I will complete and deliver to Polk County Clerk of Courts, Polk County Clerk of Courts's Request, Authorization, Consent and Release of Background Information.

Mv I understand that nothing contained in this Application, or conveyed during any interview that may be granted or during my employment, if hired, is intended to create an employment contract between Polk County Clerk of Courts and me. In addition, I understand and agree that if I am employed, my employment will be 'at-will'- that is, for no definite or determinable period of time, and may be terminated at any time, with or without notice, at either my option or Polk County Clerk of Courts's option, and that no promises or representations to the contrary are or will be binding on Polk County Clerk of Courts unless made in writing and signed by me and by an authorized representative of Polk County Clerk of Courts. Mv Polk County Clerk of Courts will protect the confidentiality of Social Security numbers obtained from employees which are used for employment purposes. Upon acceptance of employment, Social Security numbers may be collected in order to meet federal and/or state reporting requirements. Employees' Social Security numbers may be disclosed to another agency or governmental entity if disclosure is necessary for the receiving agency or entity to perform its duties and responsibilities. Social Security numbers may be required for, including by not limited to the following forms: Background checks, I-9 verification and eligibility, Federal withholding taxes, Compliance with state new-hire reporting requirements, Enrollment in company benefit plans, Unemployment Compensation claims, and benefits. All employment documents containing Social Security numbers shall be maintained in a secured area. Mv I certify that I have read and understand the job description for the position I am applying for and I certify that I can perform the essential functions of this position with or without reasonable accommodations. I also certify that all statements made on this form are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that misrepresentation or omission of facts shall be considered basis for rejection of my application or discharge if employed. My signature authorizes all of my previous employers to release any information regarding my past employment.

If made an offer of employment, I agree to submit to a pre-employment physical and drug test as a condition of such employment. Milagros villaronga 03/17/2023

Electronic Signature Date

POLK COUNTY CLERK & COMPTROLLER IS AN EQUAL OPPORTUNITY EMPLOYER M/F/D/V No person shall, on the basis of race, color, sex, age, religion, national origin, disability, or marital status be excluded from participation in, be denied the benefits of, or be subject to discrimination under any program or activity under the jurisdiction of the Clerk & Comptroller of Polk County. We appreciate your interest and the time you have taken to complete this application. Page 3

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